Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets (hemodynamic, neurologic, respiratory) and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Suspect clinically; obtain ultrasound to confirm.
- If no perforation/peritonitis → pneumatic enema reduction with surgery backup.
- If enema fails or perforation present → operative reduction.
- Observe post‑reduction for recurrence; evaluate for lead points in older children.
Clinical Synopsis & Reasoning
Episodic colicky pain, vomiting, and currant‑jelly stools in infants/toddlers. Diagnose with ultrasound (target/doughnut sign) and reduce with air enema under fluoroscopy/US when no perforation; operate if peritonitis, perforation, or failed enema.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| Ultrasound | Diagnosis | Target sign/pseudokidney | High sensitivity/specificity |
| Abdominal radiograph (limited) | Adjunct | Bowel obstruction signs | Rule out perforation before enema |
| CBC/electrolytes | Pre‑procedure | Assess dehydration/anemia | — |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Pneumatic (air) enema reduction | Mechanical | Immediate | First‑line treatment | Perforation risk small |
| IV fluids/analgesia/antiemetics | Supportive | Immediate | Stabilize prior to reduction | — |
| Antibiotics (selected) | Adjunct | Hours | If perforation/peritonitis suspected | — |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- NASPGHAN guidelines and pediatric radiology standards for intussusception — Link